MEDICARE: BEAUTIFUL SMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	42768	CA

General Provider Information

NPI Number	:	1619004090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL SMILES

Provider Business Mailing Address
First Line	:	1729 TERMINO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2121
Country	:	US
Telephone Number	:	562-494-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 TERMINO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2121
Country	:	US
Telephone Number	:	562-494-8400
Fax Number	:

Authorized Official
Title or Position	:	FRONT OFFICE STAFF
Name	:	MS. YOLANDA YOLANDA
Credential	:
Telephone Number	:	562-434-8400

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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Directions to “BEAUTIFUL SMILES ” Practice Location

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